Barriers and facilitators to nurses addressing social needs and associated outcomes in the ambulatory setting in adult patients: Systematic review

Abstract

Aim: To examine the barriers and facilitators nurses experience in addressing social needs in the United States and the associated outcomes of addressing these needs in adults in the ambulatory care setting.

Design: A systematic review with inductive thematic and narrative synthesis.

Data sources: PubMed, CINAHL, Web of Science, and Embase from 2010 through 2021.

Review methods: Cochrane Handbook of Systematic Reviews; Risk of Bias-CASP and the JBI checklist; Certainty of evidence-GRADE-CERQual assessment.

Results: After duplicates were removed, 1331 titles and abstracts were screened, and a full-text review was performed on 189 studies. Twenty-two studies met inclusion criteria. The most frequently cited barriers to addressing social needs were lack of resources, workload burden, and lack of education in social needs. The most cited facilitators were engaging the person and family in decision-making, a well-integrated standardized data tracking and referral documentation system, clear communication within the clinic and with community partners, and specialized education and training. Seven studies measured the nurse's impact of screening for and addressing social needs, and outcomes improved in most of these studies.

Conclusion: Barriers and facilitators specific to nurses in the ambulatory setting and associated outcomes were synthesized. Limited evidence suggests that screening for social needs by nurses may impact outcomes by decreasing hospitalizations, decreasing emergency department utilization, and improving self-efficacy towards medical and social services navigation.

Impact: These findings inform practice and facilitate changes within nursing towards care that accounts for a person's individual social needs in ambulatory care settings and are most directly applicable to nurses and administrators in the United States.

Reporting method: PRISMA guidelines, supplemented by the ENTREQ and SWiM guidelines.

No patient or public contribution: This systematic review is the result of work performed by the four authors exclusively.

Keywords: ambulatory care; health care; implementation science; nursing care; outcome assessment; social determinants of health; systematic review.